Dr. Debra Ravasia, Spokane gynecologist and founder of the Women’s Health Connection Clinic and the Ajuva Medical Spa in North Spokane, says she has opened an additional office in Spokane Valley to accommodate new patients, and soon will add another physician to the practice.

Ravasia specializes in treating women, but will open the practice to male patients in March, when Dr. Brian Sabowitz joins the clinic from his private practice in San Antonio, Texas.

Sabowitz, who is board certified in internal medicine, specializes in bariatric medicine. Ravasia says he will be specializing in obesity management as well as metabolic and endocrinology issues, primarily with male patients, when he joins the practice.

Ravasia will continue to see patients at her North Side practice, which occupies 3,000 square feet at 9425 N. Nevada, and at the adjacent Ajuva spa. The new Valley clinic occupies 8,000 square feet in the River View Corporate Center at 16201 E. Indiana in Spokane Valley. The Ajuva Medical Spa is a separate facility where Ravasia and her staff perform spa treatments, provide a specialized weight loss program, and offer aesthetic medical procedures such as Botox injections, laser skin treatments, and liposuction.” 

Ravasia opened the North Side clinic in 2005, specializing in gynecology and urogynecology, the practice of gynecology as it relates to the bladder, as well as obesity management. The clinic offers a variety of in-office procedures and treatments for everything from birth control to problems with hormones, she says. Minor surgical procedures are performed at a small surgical center there. 

Ravasia says she has seen the clinic grow from five employees to a total of 58 today, including her. In all, the practice employs seven physician assistants and nurse practitioners, 10 medical assistants, six health coaches, three lab technicians, and one mental health professional. The remaining employees are administrators and support staff. Many of the health care providers work at both clinics, she says.

In addition to gynecological issues, Ravasia treats patients with metabolic and endocrine issues at the clinics using nutrition, exercise, medications, and lifestyle changes. She says she prefers a holistic and natural approach, integrated with traditional medicine, to address primary health problems women commonly experience, including metabolic syndrome, menopausal issues, PMS-related problems and fertility issues. Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing the risk of chronic disease such as heart disease, stroke and diabetes, she says.

Ravasia says she has developed an intense interest in obesity management because she believes obesity underlies many hormonal and medical imbalances, as well as many chronic illnesses. 

“Weight loss also has a big impact on urogynecological issues like incontinence and leaking,” Ravasia says. “People think it’s just part of getting older, and they have to just accept it. But it’s not and it can be fixed.”

Further she believes hormonal problems also can be corrected,  when obesity is treated properly. “We’re to help patients stop taking hypertension medications and antidepressants when people lose weight,” she says. 

She says she has experienced a complete change in attitude about obesity after working with patients who have lost weight on her program. 

“We tend to blame the victim with obesity. It is a very misunderstood disease, and we’re just scratching the surface of learning how to treat it,” she says. “I feel like I’m doing the best work of my life. It’s very rewarding and we are not just putting band aids on things; we’re reversing things people said were not reversible. And we’re doing it mostly without surgery.”

One of the tools Ravasia uses for obese patients at the Valley location is a total body X-ray called a dual-energy X-ray absorptiometry, or DXA, which is  a scanner that measures bone density, total body composition, and fat content with a high degree of accuracy. 

The scanner helps get to the root of metabolic problems, she says. Scans show where fat is located in the body and whether it’s visceral fat. Visceral fat is associated with insulin resistance, which can lead to type 2 diabetes and other chronic diseases. 

Ravasia says only looking at the scale can be a misnomer with weight management. 

“There are some people that I call the skinny obese,” she says. “they look normal but their percentage of body fat could be over 50 percent. Conversely, she says, some athletes who would otherwise be considered obese are all muscle and bone, so they weigh more than what is considered normal.

“So we don’t consider weight itself very important because it doesn’t spell out body composition,” she says.

Fatty liver disease is another chronic disease is that’s on the increase, she says. “It’s caused by a high percentage of fat in the body,” she says. 

“We monitor fatty liver if it’s indicated, and we monitor it with the use of an ultrasound,” she adds.

Obesity also contributes to infertility in some cases and Ravasia says she encourages women to get metabolic issues under control before becoming pregnant.

“Insulin resistance can result in miscarriage, postpartum infection and other consequences,” she says. 

Ravasia says she has been able to treat those issues successfully in her clinics. 

“Obesity kills people,” she says. “Breast cancer and other cancers are 300 percent more common when BMI is over 30, and it’s associated with high estrogen and low progesterone.” 

Polycystic Ovary Syndrome, which causes irregular and painful periods, vaginal bleeding and weight gain are all related to insulin resistance, and the syndrome reverses once hormones are back in balance, she says.

Lifestyle medicine also is a big part of Ravasia’s overall treatment plan. 

 “Lifestyle medicine is a way of approaching medical problems that focuses on how to help you live your life in a way that improves your health. A therapeutic lifestyle involves making choices every day proactively, that will enhance your life and help prevent disease, enabling you to achieve a full healthy life,” she says. 

She says those lifestyle choices are based on scientific research showing that many chronic diseases can be prevented or even treated with changes in lifestyle. 

In fact, she says, as a provider she prescribes exercise, and the new Valley facility is equipped with a 600-square-foot gym, complete with fitness equipment. 

Her lifestyle program also includes a change in thinking about food. 

“We think of lifestyle medicine as not doing mindless eating but looking at every bite as a fuel source, rather than entertainment, and stress management is huge,” she says.